How COVID-19 has Impacted ER Capacities

image2 How COVID-19 has Impacted ER Capacities

Are long wait times and crowded waiting rooms old news in the realm of modern healthcare? The subject regularly receives introspective and critical press coverage, and much of it is negative. Unfortunately, fault-finding news articles serve to undermine the credibility of emergency medicine and the healthcare industry as a whole. And a hospital’s reputation is of paramount importance in an increasingly competitive industry. How do hospitals figure out how to plan and schedule the patients who require ordinary urgent care with those who are sick from COVID-19? Have the emergency rooms been affected by the COVID-19 pandemic or have the ER administrators done a good job of figuring out the ebb and flow of patients?

The reputation of your facility’s emergency department is also imperative to your bottom line. That’s because almost half of the country relies on emergency departments for medical care. Those without insurance and certain minority groups are more likely to use the emergency department for their healthcare needs.

Once those patients arrive at their local ER, they’re probably going to be waiting for a long time. On average, ER patients can expect to spend an average of 103 minutes in the waiting room. According to the U.S. News & World Report, Washington D.C. boasts the longest median wait times for patients, a dismal 286 minutes. Conversely, ER patients in South Dakota, home to the nation’s shortest wait times, will typically receive care within 46 minutes.

Prioritizing Healthcare During Challenging Times

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Over the years, medical professionals and public officials alike have postulated ways in which to reduce ER wait times and improve patient care. Patients have weighed in their opinions, as well. Quick care clinics have helped ease some of the burdens, but it’s not enough to stem the flow of patients. Nor can quick care clinics offset the dramatically increased demand for healthcare services in the wake of COVID-19. It’s highly unlikely that rapid care facilities have enough COVID-19 testing supplies to meet local demand. Further, their staff is much smaller than a hospital’s, leaving them overwhelmed by large numbers of sick patients.

As far as ER wait times go, COVID-19 presents numerous challenges. For starters, which medical conditions should be prioritized? Should there be separate wait rooms for those seeking treatment for the virus? Is visiting the ER safe at all during a pandemic?

At the very least, COVID-19 may ultimately provide an avenue for systematic change within the healthcare industry. The need for an overhaul in emergency medicine has become impossible to ignore. Technological advancements, including AI and telehealth, may provide a solution to ER overcrowding. Let’s take a look at the complicated issue of overburdened emergency departments under the added threat of COVID-19.

The Lowdown on ER Wait Times

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COVID-19 has dramatically complicated the issue of long wait times in our nation’s emergency department. Yet reports differ as to whether COVID-19 is reducing or increasing those ER wait times. In March, the New Hampshire Union Leader reported a noticeable reduction in ER wait times at several facilities. Those medical facilities include the Catholic Medical Center in Manchester, New Hampshire.

But that doesn’t represent the entire story: ERs across Washington state were already stretched near capacity before the onset of COVID-19. The virus compounded an already stressful situation. According to news reports, the median wait time in Washington ERs for an inpatient room is 112 minutes. The Evergreen State ranks No. 16 on the list of the nation’s longest ER wait times.

No matter one’s location, however, determining how to prioritize patients in an emergency medicine setting isn’t an easy job. ER patients are typically evaluated upon arrival as part of the triage process. ER staff members will ask questions about symptoms and medical history and may perform a simple exam. From there, patients are assigned a priority level, where Level 5 is non-urgent and the lowest priority. Level 1 designates immediate the need for life-saving intervention, and these patients typically skip the triage process altogether.

Origins of the ER

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Today, emergency medicine is a core element in virtually every major hospital across the nation. It is even considered the “most efficient way to provide emergency patient care,” according to Robert E. Suter from the University of Texas. Countless lives are saved every year thanks to the diligent work of emergency department staff in facilities of various sizes, from research hospitals to private clinics.

Interestingly, emergency medicine as a specialty is a relative industry newcomer, dating back to the early 1960s. In 1961, two separate groups of medical professionals (in Virginia and Michigan, respectively) delved into the world of emergency medicine. They did this by staffing their emergency departments. Their efforts were subsequently dubbed the “Pontiac and Alexandria Plans,” and patient care was forever altered.

Even without adding COVID-19 to the mix, emergency medicine continues to evolve. ERs are designed to primarily serve trauma patients and accident victims while providing revenue for the hospital or facility. They also double as a primary care facility for the uninsured. Also, approximately 50% of all ER services are never paid. Charitable funds are often available for those ER patients who cannot afford their medical care, especially in rural areas. These funds help bridge the gap between healthcare access for the uninsured and a medical facility’s operational costs.

Common Causes of ER Visits

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Patients who wish to utilize charitable or indigent funds to pay ER bills typically must meet certain income requirements. In general, however, the funds can be used to cover medical services for any medical condition, including COVID-19. And in the nation’s emergency rooms, medical staff must be prepared to treat everyone and every problem.

ER visits reached an all-time high several years before COVID-19 was part of America’s vernacular. 145.6 million patients visited emergency rooms across the U.S. in 2016. The most common reasons for an ER visit include chest pain and stomach pain. Exhibiting the symptoms of COVID-19 is another, more recent, reason that a person may choose to visit the ER.

But in many instances, especially those involving severe injury, a patient has little choice in the matter. For example, car accident victims should eschew the urgent care center and head straight for the nearest hospital.

Car accidents are unfortunately common across the United States. Statsia reports that about 6.3 million car crashes resulting in fatalities, injuries, or property damage occurred on U.S. roads in 2015. It’s difficult to determine the depth and severity of injuries in those crashes. But precautionary ER visits were likely involved, even when injuries weren’t initially apparent.

It’s important to note that medical care is likely to stretch well beyond the ER for the bulk of car accident victims. Recovering from a car accident can be a rigorous and lengthy process. Car accident victims may ultimately seek mental health treatment or undergo occupational therapy. Wait times tend to be much smaller within these specialty medical fields.

Ways to Improve Patient Wait Times

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On the patient end, most ER visitors know that they may be in it for the long haul. It’s reasonable to assume that the aforementioned car accident victims will end up at the top of the ER list. But the prioritization of serious injuries doesn’t mean that someone with a sprained ankle or mysterious cough should be left behind.

To help combat lengthy emergency department wait times, some facilities have implemented fast track areas and observation units. Many ER patients can be seen and treated by a nurse practitioner or physician assistant rather than a physician. Fast track units are designed to move those patients with less urgent conditions through the ER in a more timely manner.

Other facilities are using modern technology to help streamline their emergency departments. And COVID-19 is now included in fast track and remote care plans. Take, for example, St. Luke’s Health Services, which operates hospitals and clinics throughout the state of Idaho. St. Luke now offers a self-triage tool for patients exhibiting COVID-19 symptoms or who suspect potential exposure. Following self-triage, patients who require testing are prompted to call for an appointment. This simple screening process helps curb the spread of COVID-19 while also keeping ERs below capacity.

Integrating Technology with Emergency Medicine

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With all of the innovative tech at our disposal, it’s little surprise that healthcare is changing for the better. Telemedicine, such as the St. Luke’s self-triage tool, is an integral aspect of quality care in the wake of COVID-19. The benefits of telemedicine for patients are myriad. Along with increasing access to care for the most vulnerable patients, telemedicine reduces healthcare costs on both ends of the spectrum. The tech may also foster improved mental health outcomes for patients.

When it comes to innovative technology that’s impacting the healthcare industry, however, telemedicine is just the beginning. Artificial intelligence (AI) is also driving change, improving provider accuracy, and streamlining the diagnostics process.

The potential of AI seems limitless: For instance, researchers are now using AI as a means of fighting the spread of COVID-19. One new AI bot can weed out patients who have potential COVID-19 symptoms but not the virus itself. The bot is part of a screening and triage tool built by Providence St. Joseph Health System in Seattle. It’s a prime example of how AI can effectively streamline the diagnostic process.

According to Ohio University, there are several areas of medicine where AI is poised to make the most significant impact. One of these specialties is the realm of preventative care. Using data analysis, AI can identify patterns and develop personalized preventive care recommendations for patients. AI may also be used in the ER screening process to determine the urgency of a medical condition.

Navigating Uncertainty on the Front Lines

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COVID-19 effectively upended society as we know it. It’s not a stretch to say that, as a society, we weren’t prepared for a sudden pandemic. The healthcare industry may have been even less prepared. As early as February, critics were urging America’s already overburdened hospitals to take action against the possibility of a viral outbreak.

LA Times reporter William Haseltine, for example, advocated for remote diagnosis and treatment. The measure could “divert pressure away from hospitals and limit the transmission of infections in crowded waiting rooms,” he wrote. Haseltine further warned that our nation’s hospitals could quickly become “war zones” if the novel coronavirus gained momentum. Of course, that’s almost precisely what happened at the start of the U.S. outbreak.

Now we must adapt and embrace the changes brought on by COVID-19. The slowdown of COVID-19 has virtually eliminated the war zones within our hospitals. But potential ER patients remain fearful of contracting the virus as they enjoy a lengthy waiting room visit. Despite widespread fears, healthcare professionals tout the safety of our nation’s emergency rooms.

The bulk of U.S. healthcare facilities are responding in kind to COVID-related concerns. Hospitals in every state are updating safety procedures and policies regarding sanitization. And the procedural updates go well beyond the increased use of telehealth: ER staff members are donning full protective gear. Facilities are also doing their best to slash the number of workers exposed to potentially infected patients. It’s an evolving process that will continue to improve over time.

Looking to the Future

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During the initial wave of the novel coronavirus across the U.S., hospitals were deeply burdened. Few facilities were prepared for the sudden influx of potentially infected patients, and they quickly became short-staffed and undersupplied. The ethical considerations were also significant.

They remain so even as the virus’s spread has slowed. To wit, is an open wound more severe than a viral illness that has reached epidemic levels? In many cases, a patient’s medical history and demographics will factor into the decision with AI as the catalyst. Yet as technology fueled by AI helps us analyze data, it cannot make critical ethical decisions. In emergency room settings, these types of arrangements can drastically impact someone’s life — for better or worse.

Even as AI propels us into the future, emergency department patients continue to wait for extended periods to receive care. It’s a tough pill to swallow in our current era of innovative healthcare tech, where AI and telehealth rule. Healthcare administrators should do their part to reduce ER wait times, an act that may pay off in dividends. Shorter wait times improve patient outcomes while also cutting operating costs. Decreased wait times also improve patient experience and engagement.

Key Takeaways

As the novel coronavirus swept across the world and the nation, we watched in awe as hospitals morphed into makeshift battlefields. Under the threat of the worst global pandemic most of us have ever seen (or ever will see), uncertainty has become part of everyday life. COVID-19 has forever altered the ways we communicate and interact within the world. And the healthcare industry is at the center of the action.

In regards to emergency departments, embracing modern technology is one of the easiest ways to foster lasting change. If we remain diligent and adaptable, perhaps every state can eventually reach ER wait times to rival South Dakota’s.

Brooke Faulkner

Brooke Faulkner is a mom and writer in the Pacific Northwest. She is passionate about sharing her knowledge about the healthcare industry to help both healthcare providers in providing quality care, and families like hers in getting the healthcare they need.

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